B-PO03-054 OUTCOMES OF TRANSVENOUS LEAD EXTRACTION USING THE TIGHTRAILTM MECHANICAL ROTATING DILATOR SHEATH

Abstract

The TightRailTM is a mechanical rotating dilator sheath widely used in transvenous lead extraction (TLE). Approved in 2014, there remains limited data on procedural outcomes. To describe outcomes of TLE using TightRailTM and predictors of clinical success. Patients undergoing TLE with leads targeted using the TightRailTM as the first and (if required) second tool were identified from a single center prospective registry (2013-2019). Clinical success was defined as lead removal with residual fragments, if any, <4 cm not impacting procedural goals. Lead and patient characteristics associated with successful extraction were analyzed. 189 leads (124 patients) were included. Mean lead age was 12.6 years (+/- 7.9 years) with 59 ICD leads (38 dual coil). Success with first TightRailTM use was 59% (114/189). 46/75 remaining leads were targeted with TightRailTM as the second tool. In this group, success rate rose to 91.1% (144/158). For the remaining 14 leads, 11 were successfully extracted (5 - TightRailTM, 6 - other tools) resulting in overall clinical success in this cohort of 98% (155/158). Lead age > 10 years and dual coil ICD lead were associated with lower success rate with the first TightRailTM use on a target lead. There were 3 adverse events including 1 death (sepsis complications) and 2 SVC tears, both with high-risk features including lead dwell >30 years with SVC occlusion in one patient and lead dwell >12 years with dual coil ICD lead in the other. In this series, which to our knowledge is the largest to date, the TightRailTM is an effective tool for transvenous lead extraction. Further evaluation in prospective studies is warranted.